FND-Workbook-For-Group

.pdf

School

Lewis University *

*We aren’t endorsed by this school

Course

NURS-233

Subject

Medicine

Date

Apr 3, 2024

Type

pdf

Pages

20

Uploaded by SargentInternet11790 on coursehero.com

Functional Neurological Disorders Recovery Workbook A collaborative program developed by the Department of Neurology & Department of Psychiatry University of Colorado 2020
Creating a support plan: The FND clinic providers are unable to provide urgent or emergent mental health or medical services. If you are experiencing a mental health emergency, please call 911 or go to your nearest hospital emergency room. If you are experiencing a crisis you may also contact Colorado Crisis Services at 1-844-493- 8255 or text “TALK” to 38255 Support Plan: 1) Who has helped me in the past when I am having a seizure? What do I need in order to feel supported when having a seizure? 2) Who helps me when I am sick? Where do I turn for help when I am in pain? 3) What do I do when I’m feeling depressed or overwhelmed? What do I do to cope? Do I have anyone or anywhere that I turn to? 4) If things get so bad that I am feeling hopeless or are having thoughts of wanting to hurt myself or end my life, where do I turn to for help? What has helped me in the past?
Introduction: Welcome to the Functional Neurological Symptoms Disorder Clinic (FND)! We have been treating patients with FND since 2014. At this time, we mainly treat patients with Non-Epileptic Seizures (NES), a common type of FND. This workbook is designed for use by each individual to keep track of symptoms and steps to recovery. It is also intended to answer many common questions about FND. The FND clinic is a time limited program with the expectation of an average 6 months of treatment. We are unable to perform chronic ongoing care after the clinic discharge at 6 months. It is important to have a good working relationship with your primary care physician to help them understand your FND in order to create a smooth transition out of FND clinic once treatment is complete. Our clinic has limited ability to complete and fill out paperwork. We make an exception for transportation paperwork if it relates to transportation for your treatment in the FND clinic. The best person to complete any paperwork needs for disability or other needs is your primary care physician. Patients complete assessments before enrolling in the FND clinic. All patients will see a neurologist and a behavioral health provider, followed by decisions about the best treatment pathway, which is most often group treatment. The group treatment takes two main forms: cognitive behavioral therapy (CBT) based psychological-education and multi-modal psychotherapy. Our goal is to improve your symptoms in order to return you back to your community providers with the tools you need to continue your recovery. Completing the NES program takes approximately 6 months. During this time, you will be assisted to establish ongoing- care for transfer to community providers. This may include establishing a primary care physician, individual therapist and a mental health medication provider if needed. Please bring your workbook (including diaries if you are asked by the neurologist to track your events) to each of your individual and group appointments and be prepared to discuss what you have written. Accurate Assessment: A neurologist makes the diagnosis of FND, in the case of NES using an EEG. The clinic team completes further screening to assess for common needs in patients with FND which can include other physical health problems, or co-existing mental health problems like depression, anxiety or post-traumatic stress disorder, for example.
Current coping skills, and any challenges with family relationship patterns are also explored as part of a complete assessment. State of the art treatment: Our neurologists and psychiatrists have worked with the national experts in FND treatment to establish the FND program to provide the best care available for patients. It is an innovative treatment approach that is among the first of its kind in the United States. Treatment consists of group psychoeducational CBT sessions that provide psychological support and education about FND. If needed, a patient may receive individual treatment with neurology, individual treatment with psychiatry, treatment with physical and occupational therapy, and a family assessment and treatment. Mental-health and neurology intake appointments last from 60 - 90 minutes and follow-up appointments are 20 – 30 minutes. Is mental health treatment necessary? Some people believe that treatment by a psychiatrist or other mental health provider is a sign of being “crazy” or otherwise mentally incompetent. This is not the case. The co-existence of mental health issues is very high in patients with an FND diagnosis. We believe in taking care of the whole patient which means that we must address physical and mental health needs. It makes sense to seek treatment from a professional most able to help you with treatment which is specifically directed at your particular diagnosis. Psychological influences can best be identified with the help of those with special training in this area: psychiatrists, psychologists, or clinical social workers. As with all other medical conditions, sometimes the exact cause remains unknown; even so we can concentrate on the most important goal: reducing or eliminating symptoms. What is the prognosis? With active participation with prescribed treatment, the prognosis is positive. Properly directed treatment can improve the symptoms of FND in as many as 80% of patients. Keep in mind that treatments are not a quick fix, and take time. A common challenge happens when patients struggle to accept the diagnosis and as a result do not attend their appointments. Illness which requires treatment will not get better without it. In the case of FND beginning treatment as soon as possible is very important. It is known that the sooner appropriate treatment begins, the better the chances of a full recovery.
Memory Problems? Many patients with FND have significant difficulty with their memory. This is in part, due to the work of processing memories, emotions and thoughts which are related to FND. The brainpower needed for this processing leaves less space and brain energy for other functioning. At the severe end of the spectrum, this processing leads to a problem called dissociation. Dissociation is common in patients with FND and can be one of the reasons for problems with the working memory for everyday life. Often, addressing the emotions, etc. which are consuming the brains capacity to function well, can help this problem. Here are some other tips and resources for improving working memory: 1. Get adequate sleep, nourishment and exercise. 2. Avoid multitasking so that you can focus your attention. 3. Explain new information to yourself in your own words. Use rewording and summaries to help remember complicated information. 4. Use memory aid strategies (e.g., using the word BAT to remember to buy bananas, apples and tea). 5. Use memory strategies that work for you. If visualizing things helps, use that technique. 6. Elaborate the details of the memory (e.g. Try to remember someone's name by remembering that their name is the same or similar to someone else). 7. Write things down. Some patients find a day planner to be useful. What about marijuana? Marijuana use in patients with FND is common for multiple reasons. Marijuana has not been studied in patients with FND and therefore we don’t have information on the safety of marijuana for FND and want you to be aware of the potential adverse effects associated with use. There is good evidence that long-term use of marijuana can have negative effects on memory and ability to learn. This already tends to be a difficulty experienced by patients with FND. Marijuana is also associated with poor psychiatric outcomes including a higher risk of anxiety, depression and psychosis. Marijuana can decrease the effectiveness of prescribed psychiatric medications making treatment of conditions more difficult. Marijuana may also be used as an avoidance strategy to escape emotional pain. In the FND program our goal is the opposite, to get patients to start facing difficulties that have been previously avoided. Greater frequency of cannabis use increases the likelihood of developing problem cannabis use.
Marijuana has a specific withdrawal phenomenon that can lead to discomfort if stopped abruptly. These withdrawal symptoms are similar to the withdrawal symptoms from other substances of abuse like anxiety, moodiness, irritability, restlessness, insomnia, sweating, and abdominal pain. These symptoms are worse in the first week of stopping and generally improve quickly but can last for up to 6 weeks. The best way to avoid withdrawal if wanting to stop or cut back on your marijuana use is to decrease your marijuana use by 20% each day. In the FND clinic, we do not recommend or prescribe marijuana to treat FND or any psychiatric co-morbidities. Cannabis can also have health consequences with the most recognized being cyclical vomiting (Cannabis Hyperemesis Syndrome). In some studies, cessation of cannabis use has led to resolution of these symptoms. More information on the use of marijuana can be found at The National Academies of Science Report on Cannabis and Cannabinoids which can be found here: http://nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and- cannabinoids.aspx Additional Questions: Please go to www.nestreatmentucd.org
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
  • Access to all documents
  • Unlimited textbook solutions
  • 24/7 expert homework help